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The Natural History of Spondylolysis and Spondylolisthesis: 45-Year Follow-up Evaluation

Beutler, William J. MD*; Fredrickson, Bruce E. MD*; Murtland, Albert MD†; Sweeney, Colleen A. MA*; Grant, William D. EdD*; Baker, Daniel MD†

Clinical Case Series

Study Design. A prospective study of spondylolysis and spondylolisthesis was initiated in 1955 with a radiographic and clinical study of 500 first-grade children.

Objective. To determine the natural history of spondylolysis and spondylolisthesis.

Summary of Background Data. Most studies on the natural history of spondylolysis and spondylolisthesis are based on patient populations presenting with pain. Critical to any natural history investigation is the study of a population of affected individuals, whether symptomatic or not, from onset of the condition through their lives.

Methods. By study of a population from the age of 6 years to adulthood, 30 individuals were identified to have pars lesions. Data collection at a 45-year follow-up assessment included magnetic resonance imaging, a back pain questionnaire, and the SF-36 Survey.

Results. No subject with a pars defect was lost to follow-up evaluation once a lesion was identified. Subjects with unilateral defects never experienced slippage over the course of the study. Progression of spondylolisthesis slowed with each decade. There was no association of slip progression and low back pain. There was no statistically significant difference between the study population SF-36 scores and those of the general population the same age.

Conclusions. This report is the only prospective study to document the natural history of spondylolysis and spondylolisthesis from onset through more than 45 years of life in a population unselected for pain. Subjects with pars defects follow a clinical course similar to that of the general population. There appears to be a marked slowing of slip progression with each decade, and no subject has reached a 40% slip.

From the *State University of New York Upstate Medical University, Syracuse, New York,

and †Guthrie Clinic, Sayre, Pennsylvania.

Funded by a research grant from the North American Spine Society.

Acknowledgment date: April 18, 2002.

First revision date: October 2, 2002.

Acceptance date: October 7, 2002.

Device status/drug statement: The submitted manuscript does not contain information about medical devices or drugs.

Conflict of interest: Professional organizational funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.

Address correspondence and reprint requests to Bruce E. Fredrickson, MD, SUNY Upstate Medical University, Orthopedic Surgery, 550 Harrison Center, Suite 130, Syracuse, NY; E-mail: fredricb@upstate.edu

© 2003 Lippincott Williams & Wilkins, Inc.